Ankle Fusion Surgery
This procedure is generally performed as a day case operation. Usually it is an arthroscopic procedure unless it is a revision or complex case where we do open fusion. You will be coming to the day case reception lounge on the day of operation. You will be checked into preoperative lounge and will be met by the surgeon and the Anaesthetist who will go through all the benefits and risks of the surgery again. Surgery is performed under general anesthetic, usually as a day case. The procedure takes around 2 hours. Patient can usually go home following arthroscopic surgery on same day or may have to stay for 1-2 days if procedure is more complex or in revision cases.
2 small incisions are made at the front of the ankle to allow the camera (arthroscope) and the instruments access to the ankle joint. Any remaining cartilage is removed as is the hard-underlying bone by using motorized shavers. After preparing the joint, 2-3 screws are placed from the either side of the shin down into the ankle through a 2cm incision.
The tissues are then stitched, and a below-knee back slab applied.
Open Ankle Fusion Technique
A 12cm incision is made, usually over the outer side of the ankle. Any remaining cartilage is removed as is the hard-underlying bone by using chisels. When the joint has been prepared 2-3 screws will be placed across the ankle joint. The screws are 7-8mm in diameter. The tissues are then stitched and a below-knee back slab applied.
All surgery carries potential risks. The risks are minimized by having the surgery meticulously performed by an expert in foot and ankle surgery.
- Pain, swelling, and bruising – This is common following ankle surery.You have to keep your limb elevated for 48 hours to prevent swelling.
- Infection – 1% or less risk.Slightly higher in open fusion .
- Numbness - can occur over the top of the foot, and usually improves over time
- Blood clots (Thrombosis)- You will be put on Low molecular weight Heparin prophylaxis to reduce the risk of blood clots in calf, thigh or rarely in lungs.
- Stiffness –The ankle joint will be stiff following surgery. There is risk of adjacent joints to get arthritis over time.
- Delayed or non-union - the non-union rate (bones not healing together) is approximately 5% and is higher in people who smoke.
- Scar sensitivity – usually improves with time.
Discharge advice following ankle fusion
You will be put on a below knee back slab following surgery for two weeks.
You have to keep the limb elevated to reduce the swelling. It will occur to some degree following all foot and ankle surgery. Try not to hang your leg down for two weeks after surgery. The swelling can sometime last for 6 months. Keep it elevated on a pillow for first two weeks.
You will receive a prescription for pain medication on discharge. Pain is often due to swelling, and this is eased by rest and elevation of the foot.
A physiotherapist will have shown you how to use crutches. You should not put any weight on the foot for at least 2 weeks.
You will be seen in our clinic at 2 weeks when we will remove your sutures from the wound and put in a removable aircast boot. You will be non weight bearing for further four weeks after suture removal. When you come back for further review in 6-8 weeks we will get further x-rays to view the progress of ankle fusion. Normally fusion can take 4-6 months to take place .We will follow you up until ankle is solidly fused. After 8 weeks we will allow weight bearing as comfortable in boot and after 3 months you can start weight bearing unsupported.
Driving and work
You can start driving an automatic car by 8-10 weeks. But if you are driving manual car it is advisable to drive after 12 weeks.
If you have an office-based job, then it may be possible for you to return after 2 weeks however it is more advisable to return after 12 weeks. If you have a more physical job, then it may take 16-20 weeks.
It often takes 6 months for all swelling to resolve and so minor swelling late in the day is not unusual and should not be a cause for concern.